February 11, 2015

This week I came home to New Orleans and attended the International Disaster Conference. One of the vendors I found is focused on something that should be a concern for every community - knowing where to find your at-risk populations -- those vulnerable to be left behind in a disaster.

AtRisk Registry arose out of the Katrina disaster and provides a mechanism for managing the physical location and medical status of anyone with medical, mobility or special needs. This is a topic I've discussed during recent business continuity planning activities, and one that has arisen during fires in my own community.

So I ask, if you have responsibilities for disaster preparedness, would you quickly and easily know where to locate and get the right kind of assistance and/or transportation to:

hospice, home care and other home-bound patients

seniors or others with mobility limitations

individuals with disabilities

children or adults with special needs

Not knowing creates added risk that these individuals would need care at a higher level, be harmed or possibly left behind in a disaster.

January 26, 2015

Not long ago I came across a wonderful quote by Albert Camus from his book The Plague. I realized I had not yet read this classic, so I used the quote in a recent article, Clean Hands Saves Lives, and downloaded an audio copy of the book for my long drives.

"What's natural is the microbe. All the rest — health, integrity, purity (if you like) — is a product of the human will of a vigilance that must never falter. The good man, the man who infects hardly anyone, is the man who has the fewest lapses of attention. And it needs tremendous will-power, a never-ending tension of the mind to avoid such lapses."

This book, like The Geat Influenze, begins just as signs of an epidemic begin to emerge and we see how the population and individuals respond. We watch as social norms begin to evolve as the community is cut off from the world around it in an effort to minimize the spread of the deadly disease. We also see how the disease itself evolves and mutates. The most important lesson from this book, and others , is that epidemics don't happen often, but they do occur. Other lessons include:

We can expect our government officials to not want to recognize the dangers -- hoping the situation will resolve or be brought under control -- soon

We can expect the painting of a rosy picture even as death and disruption plays out before our own eyes

Sooner or later, we can expect that the unbelievable will become more believable and that individuals will adjust to a new social order

We can also expect that some individuals will lose self control and exhibit behaviors that disturb our peace and social norms (both the new and the old)

We can most certainly expect that the situation will ultimately resolve, but it will take much longer than we could ever have imagined.

All of this points to the importance of being prepared as a way of helping us ease into the change as we transition into a new way of life. Perhaps this will never happen in my or your lifetime, but if it does I believe these lessons will serve us well.

January 16, 2015

One of my Multibrief articles made the list of ATA Telemedicine News Brief's list of most accessed content articles. It was written in August 2014, so we can all expect that additional states now have Text 911. Since it was so popular, I've re-printed here.

The Federal Communications Commission (FCC) has taken another step toward a 911 system that fits with how Americans are communicating. The new rules, adopted Aug. 8, will make Text-to-911more uniformly available by the end of 2014 —and this has important mHealth implications.

The four largest wireless carriers already support Text-to-911, but the new rules establish a timeline for the remaining text messaging providers to be prepared to support Text-to-911. This will ensure that all wireless carriers and certain IP-based text applications are prepared to respond to requests from 911 call centers.

Over 100 emergency call centers servicing portions of 16 states and two entire states (Vermont and Maine) already accept text messages and have collected examples of how they have helped save lives. The capability is important because 7 out of 10 Americans send or receive text messages, and some populations — including minorities, the young, Medicaid beneficiaries and the homeless— prefer text messages to voice calls.

There are also significant mHealth implications for being able to send a text message to reach 911 emergency call-takers from your mobile phone or device. This includes better access for disadvantaged populations, but also for individuals who are deaf, hard of hearing or have speech disabilities. This potentially life-saving alternative will also be valued when voice could endanger the caller.

Additionally, if one considers the fact that 800 text messages equal the bandwidth of a one-minute call, the option of texting 911 could also be the difference between life and death when voice lines are congested — such as during disaster events, or in rural and remote areas with limited or spotty cell coverage.

Healthcare leaders will want to determine whether text 911 capabilities exist in their community and update their emergency communications plans. During a disaster, if other communication mechanisms fail, a text message to 911 may be their only connection to other emergency responders and resources. They will also want to determine whether their organization has a homegrown IP-based application that will need to comply with the new rules.

Key patient populations who could benefit from Text-to-911 may need to be identified and educated on how to use this service in an emergency. But, most importantly, healthcare organizations should recognize the growing patient expectations around text messaging and start to apply this communication tool in other areas of their operations, such as for scheduling and appointment reminders or other care coordination communications.

November 03, 2014

My latest article for Multibriefs addresses the risk of being unprepared for events like the current evolving situation with Ebola. Healthcare providers have a responsibility to be prepared and the government has a responsibility for supporting the planning process, including with funding.

In the case of the hospital who did have an Ebola positive patient walk through the doors, they weren't really prepared. A more proactive hospital may have researched how caregivers were protecting themselves in Africa, trained staff earlier, identified an Ebola Response Team and/or conducted a tabletop exercise.

A more proactive CDC may have recognized that standard Universal Precautions weren't enough and have had more detailed guidance available for providers that leveraged the lessons learned from African caregivers. For months we had been seeing pictures of staff with PPE like the one below on the news. Did no one ask why caregivers in Africa seemed to be more fully covered?

The reality is we didn't invest the energy and resouces into planning because we didn't think it would happen to "us". Disaster planning and emergency preparedness is accepting the fact that it can, and will, happen. It is also about not assuming that others, like the CDC, will do it for us or waiting for them to do so.We learned this after Hurricane Katrina, but seemed to have forgotten that effective healthcare leaders take control of their own destiny.

Update: Nov 11th:

I came across two Modern Healthcare Articles with some excellent commentary and a quote. They are

"Ebola not only infects patients, it can infect the corpus of hospitals as well..... This corporate version of the Ebola infection can, in a matter of days, bring healthy hospitals to the verge of business mortality, as well."

September 17, 2014

Over the years I've contributed articles to several publications, and often repeatedly, because we have built up a mutually beneficial relationship. As a writer, I think any of them will tell you I produce on time and the continuing invites seem to indicated my writing skills are good and there is something to what I have to say.

The latest of these partnerships is Multibriefs and my contributions to newsletters for several healthcare administration associations. (Perhaps you are a member of one of the associations and have already seen one of these articles.) One result of writing for someone else is that it cuts into the time I have for my own blog... thus you may have noticed recent infrequent posts.

By sharing links to my first four articles for Multibriefs, I hope that I will continue to maintain your interest until I re-balance and can acclimate to my new obligations. I also believe each has the possibility to stimulate some new ideas.

June 25, 2014

For months I've been listening to books for leisure, but with this latest I'm back on to my professional interests. However, this one is also personal.

If you are involved in hospital, sub acute or SNF leadership or active with ethics, disaster planning or emergency preparedness in your healthcare organization, you need to read this book. You also need to read this book if you are a physician... or nurse.

During and after these five days at the hospital I know as Baptist (my dad worked in Central Supply and Purchasing many, many moons ago) there was great pain, suffering and difficult decisions. From hearing all of the "evidence" I must say it was all due to poor planning and unengaged leadership at the top. The lack of strong leadership lead to delays in response and recovery and scenarios that placed hospital employees in difficult positions.

I know, I wasn't there! However, several places along the way I know I would have made different decisions. For one, if I were CEO/COO/CFO I would have been present, continually assessing the situation and adjusting plans accordingly. I would NOT have just sat around and waited for the "government" to come and bail me out.

This book comes down to the ethical decisions that take place during emergencies and disasters including intentionally ending a life. It goes beyond the hospital staff to also include the community and political response and highlights the importance of having the most difficult conversations before disaster strikes

If you have read the book, do you believe each of key patients mentioned in this book were treated in a manner that would be deemed acceptable? Would you have been proud of these results had you been the hospital CEO? I think we can, and have, done better! Lets learn from the mistakes and not repeat them!

By the way, on the discussion at the end I believe a team should make the needed decisions on a case by case basis weighing the resources available and the risks. I also believe patients and families deserve an opportunity to contribute.

June 11, 2014

The idea of a gun violence restraining order is being proposed in wake of the recent killings just off the UCSB campus and the warning signs that were fully recognized too late. The idea is that family and friends could seek a restraining order from a judge in an effort to potentially prevent violent individuals from buying or keeping guns. The judge, upon examination of all evidence and consideration of factors indicating risk of self harm or harm to others, would then sign an order temporarily stopping an individual from buying or possessing a firearm - and periodically reassess. This decision would create a clear path of action for police and judicial authorities to search for and confiscate weapons if they believe individuals could be a threat to themselves or others.

I have worked in healthcare for 35 years and some portion of this has been in acute psychiatric hospitals and consulting to community mental health providers. During this time, I've had to navigate the fine line between HIPAA/patient rights/laws and interventions in situations where there was only a perceived risk for escalation. After this most recent event I wondered if it was time to revisit the 5150 criteria of danger to self, danger to others or gravely disabled.

I do recognize that individuals who are truly intent on doing harm to others or themselves will likely be successful - ultimately. Thus, in some cases we must accept, learn from and move forward from unfortunate events. However, there are times when we could have done more - but public policy stood in the way. Each time these recent events and the investigations unfolded, we identifed missed opportunities to intervene and change the course that lead to death and destruction of lives.

Some Background Contributing to the Current Enviroment

During the Reagan Administration the mental health system changed dramatically. The vision was to de-institutionalize and provide services in local communities. It was a good idea, but unfortunately funding for the envisioned community supports did not materialize and community mental health is still trying to catch up.

During the Managed Care squeeze of the mid-1990's, benefits for psychiatric and chemical dependency (often self-medication of underlying psychiatric issues) coverage were slashed and denials for care from insurance companies were the norm. Parity (with medical care) was a huge debatable issue and still is a bit of a challenge today.

As a society, we don't lock people up as in the past and we have evolved, better understand, don't fear mental illness and respect individual freedoms. However, the evolution of the care delivery system needed to support mentally ill individuals hasn't kept up.

Role of Family (and Friend) Caregivers

We have been living with the regulations for involuntary holds for some time now. Unfortunately, too often family and friends have concerns and "suspiscions" and we say we are sorry but they "don't meet the criteria". Additionally, without some indication of risk at the moment, law enforcement is limited in their ability to look deeper into the situation.

In the medical world, we are recognizing the important role family caregivers have on helping the patient recover, minimize the risk of relapse, comply with their treatment plan and stay healthy. Families have always had this role with their mentally ill loved ones, but again public policy sometimes leaves them feeling helpless when they know in their heart and soul that things are really bad. Healthcare providers must be able to listen and act.

It is time to revisit the 5150 hold criteria and the triggers that demonstrate compliance and/or consider new approaches such as the gun violence restraining order described above. Either way, we do need to put a bit more faith into the insight that family and friends are trying to express. We must collect information from those closest to the patient and with all of the information make a more informed decision about the need for a 5150 or other intervention. We must also provide protections against HIPAA violations and address provider fears of violation so that professionals feel more comfortable speaking up and sharing relevant information when they have legitimate concerns.

I don't want want to limit our efforts to guns, because if you are mentally ill and dangerous, you will find a way to secure the tool(s) needed to carry out your plan -- guns, knives, cars, bombs, planes, screaming fire/bomb in a confined and crowded space or otherwise. This is about identifying those at risk for escalation and carrying out plans to destroy others and themselves and limiting their options to secure tools of destruction. Having said this, relying on acute psychiatric hospitalization before being placed on the list preventing the purchase/possession of a gun isn't enough when the pressures (especially reimbursement/payment) greatly limit hospitalization.

Continuing as we have means we need to recognize that it isn't a matter of if another one of these potentially preventable events will happen, but when, where and how. Please let me know what you think!

May 17, 2014

HHS has released a new security risk assessment tool to help providers, and perhaps business partners, uncover potential weaknesses in their security policies, processes and systems. Using the tool, providers will be guided as they address risk and security practices and failures such as:

personnel issues

defining and managing access

backups

recoveries

technical and physical security

In addition to helping providers manage their risks and comply with the HIPAA Security Rule, I believe the tool is also helpful with business continuity planning efforts. Think about it - will the organization be able to survive if there is a breach or if security weaknesses become widely known? How does security change during a disaster?

May 05, 2014

My blog seems to have opened up a floodgate of physician writers. The first trickles came from Dr. Gelber and Dr. Parsons, but I've now been introduced to a couple of new writers and medical mystery and suspense is becoming a trend. This post is on DJ Donaldson, a retired professor of Anatomy and Neurobiology at the University of Tennessee Health Science Center, who has seven forensic mysteries and five medical thrillers.

When I was first asked to review Bad Karmain the Big Easy, I was particularly excited by the fact that it is set in my hometown - New Orleans. In the aftermath of Hurricane Katrina, when the police force is still in disarray and records have been destroyed, the medical examiner is diligently fulfilling his responsibilities in the temporary morgue in San Gabriel (a place I passed on my way to LSU many times). He discovers three nude bodies, all young women, none with water in their lungs, and realizes this is not an act of God. This pathologist will do what ever he can to find the killer.

The medical mystery, a realistic setting and description of working in an austere environment came together to make it a great read! I enjoyed the book and think my readers will too!

Stay tuned, there is another physician author who will be covered soon.

February 27, 2014

I received many press releases, but don't post on the vast majority. But, the one below, from Congresswoman Rosa DeLauro on her comments at the first Labor-HHS-Education Appropriations Subcommittee Hearing Of 2014, is different. It is different because I've been attending to emergency preparedness most of my career and most recently have been involved in the HPP program in three counties along the central coast of California. So, I share the Congresswoman's comments here in their entirety.

WASHINGTON, DC--Congresswoman Rosa DeLauro (D-CT), senior Democrat on the Labor, Health and Human Services, and Education Appropriations Subcommittee, made the following opening statement at the subcommittee’s hearing today. The hearing focused on the future of public health emergency preparedness.

“Today, this subcommittee is evaluating our efforts to become better prepared to deal with outbreaks of deadly diseases, particularly through development of new and better drugs and vaccines. Many of the efforts we will hear about today are aimed at limiting the harm from deliberate biological or chemical attacks, such as the spread of anthrax here in Washington twelve years ago. These programs were begun or greatly expanded in the last 10 or 12 years, in response to growing recognition of serious gaps in our public health preparedness.

“There have been some successes. Take flu for example. There was a time in the last decade when we were down to just one manufacturer of flu vaccine in the United States, with only limited capacity to scale up production to respond to an epidemic. Today, we now have a much-improved production capacity for the flu vaccine.

“That being said, I think there are serious questions as to whether the vast resources that are dedicated to these programs are being spent in the most efficient manner to protect the public health. For example, we find ourselves 10 years into the BioShield program, having spent a whopping $3.1 billion, and we have to look at what have to show for that.

“Certainly an improved stockpile to deal with anthrax and smallpox. Yet there is clearly a much wider spectrum of threats that confront us. We also need to be much better prepared to deal with emerging threats that occur naturally. Threats like the spread of novel diseases like SARS, the emergence of microbes that have become resistant to the drugs used against them, and both pandemic flu and ever-changing seasonal flu viruses.

“I realize that BARDA has produced a broader range of products that are still in the development pipeline, but when these efforts were launched a decade ago, we expected to be further along by now. So I think our track record in developing medical countermeasures is decidedly mixed. Just as important, we need to recognize that public health preparedness involves much more than simply developing and stockpiling drugs and vaccines.

“We also need enough well-trained epidemiologists and other health professionals to identify, investigate and track disease outbreaks. We need enough laboratory capacity to analyze large volumes of samples and determine what pathogens are involved. We need effective plans and enough supplies and personnel to efficiently distribute and dispense vaccines and treatments. We need the surge capacity in our hospitals and other facilities to take care of large numbers of seriously ill patients.

“All of this work needs to be done through partnerships between federal agencies like CDC, state and local health departments, and the medical and first responder communities. Unfortunately we have spent the past 5 to 10 years cutting federal support for these critical state and local preparedness activities. Adjusted for inflation, CDC funding to state and local health agencies has declined by nearly 50 percent in the past 10 years.

“Similarly, the Hospital Preparedness Program, which provides grants to states to improve the preparedness and resiliency of their healthcare systems, has declined by about 60 percent These cuts are causing state and local health departments to eliminate staff, they cut training exercises, and forego critical medical equipment and technology.

“Addressing all these needs has become a real challenge for our subcommittee, in light of the tight budget limits that are being imposed. Much of the PHEMCE enterprise is really a new cost to this subcommittee that has to be fit within our constrained allocations. Until this year, all of Project BioShield and most of BARDA had been supported from a ten-year advance appropriation made back in 2004 in the Homeland Security Bill. Much of the pandemic flu preparedness activity has been supported through balances of emergency supplemental appropriations made in 2006 and 2009.

“However, now, those funds are either expired or almost depleted, and this subcommittee had to start covering the costs—$800 million in FY 2014—through annual appropriations. Without a different scale of allocation for this subcommittee we had to take on the $800 million and that had to come from someplace. And it came from other areas.

“These needs are all important and these investments provide tangible returns for the public. The subcommittee will do the best it can to take care of them. But as long as this subcommittee’s totals continue to be so tightly constrained, it will be extraordinarily difficult to provide adequate support to these countermeasure programs and adequately take care of our many other public health priorities.

“I’ll just give you one: the NIH, which only saw roughly 58% of its sequestration cuts restored in its 2014 budget, that provide so much of the basic scientific support for these efforts, as well as the other pieces at CDC and elsewhere necessary for public health preparedness will suffer.

“In short, there are real and potentially grave consequences to the budget decisions we are making. Weaker defenses against infectious diseases and slower progress in advancing medical science generally may well be one of those consequences. So today, I look forward to a discussion of both the current status of the PHEMCE programs and the challenges that we face ahead. Thank you again for joining us today and I look forward to your testimony.

November 14, 2013

I came across a great example of using social media for disaster preparedness activities. It is a YouTube video of Vandenberg's 30th Medical Group training on In-place Patient Decontamination. Beyond just sharing the video of the with the world, this is also an opportunity to enhance the after action (debriefing) conversations and the actual exercise report. It goes beyond just describing what happened, to actually being able to show what worked well or needs improvement.

It think having a social video also provides an opportunity to share the story with employees who might not have been involved in the actual exercise. I think back on my Maintenance guys at Ventura County Medical Center and Santa Paula Hospital who could set up a decontamination tent really fast. It might have been nice for others across the organization to see them in action, as well, but making the video available on a hospital blog, the Intranet, or even on a YouTube channel.

Making the video publically available is also an excellent way to share some of the behind-the-scenes work that hospitals do for the benefit of their communities.

April 19, 2013

I’ve been watching some of the news coverage of the bombing
incident in Boston, but have been focused on those aspects related to emergency
response. This event is a reality check
for me because just a couple of years ago I was participating in the planning
of an exercise scenario that included two bombs going off at a local 10k race. In our scenario, the plan was to
have the second bomb explode as emergency crews responded, rather than targeting
the dispersing crowd.

I think a recap of what I have seen and remember from our
surge exercise will serve as some lessons learned.

Events with large accumulations of people are an
excellent opportunity to test preparations for surges. In this case a medical tent was set up,
staffed and supplies were available. The
level of preparedness seen probably contributed to a significant reduction in
mortality.

Our new reality is that sometimes these
resources will be needed for reasons beyond the additional scope. Also having a stock of basic burn and trauma
supplies available addresses this reality.
I’d also recommend having some supplies and/or equipment for chemical
decontamination or at least a stand-by plan.

It was amazing to see so many patients in
wheelchairs so quickly. Equipment needs
seem to have been well planned and probably helped expedite movement of
patients from the medical tent to staging areas for transportation to
hospitals.

Training – perhaps by instinct or because of
training, most volunteers seemed
prepared to response. Today’s reality
makes conducting stimulated emergency response exercise with staff and
volunteers a necessity – even if it is just a tabletop.

So far, I haven’t seen any pictures from inside
the medical tent. Hopefully, the lesson
of having reporters inside tweeting what they were seeing in Joplin, MO was
learned.

The hospitals shown in the various reports all
seemed or were on lockdown as a result of this incident.

My closing thought is to recommend that everyone participate
in community emergency planning activities or events. If there is a CERT program in your area, join
it and prepare. Doing so honors those
who were impacted by this act of evil.

October 18, 2012

By the way, I saw this in action here in California during the last hurricane to roll through New Orleans. Family and friends gave updates, especially on flooding, loss of power, safety, etc. Sometimes, more importantly, those with power shared the news and offered to assist those without. It was faster than the traditional sources of information and more personalized!

October 11, 2012

Ever been in an earthquake? It can be pretty scary. On October 18th, Shakeout.org is hosting the largest ever earthquake drill. In as little as 90 seconds you can learn and practice what steps to take to protect yourself and those around you right from your computer! Join the 14 million other participants and get educated.

September 14, 2012

One of my Santa Paula fire-fighting friends has a new blog and I'm hoping some of my readers will go visit his writings on being prepared for a disaster! His first post was about the People Like You video, which is truly a great educational and motivational tool!

As I often say, the best prepared hospitals are those whose employees are prepared at home!

June 04, 2012

The shift to more digital healthcare environments means that health IT disaster recovery planning is even more critical than it was in the past. Not long ago, Health Management Technology had an article that does a nice job of taking readers through the planning process; including identifying critical systems applications and prioritizing those for order of restoration... in advance.

A good resource focusing on the front end, from the National Cybersecurity and Communications Integration Center, covers issues of cybersecurity and continuity of operations planning for IT disaster events. It does a nice job of reviewing risk assessments, identifying potential points of entry (including those implantable medical devices) and addressing mobile device risks.

The Department of Homeland Security is offering to conduct onsite Cyber Resilience Reviews (CRRs) of hospitals and details are outlined in a fact_Sheetand list of FAQs. If you are in California and want additional information, call the Cal EMA in the Office of Infrastructure Protection at 916 845-8893.

Just in case you are wondering my best practices for today are in green!

May 29, 2012

Dr. Ken Cohn is one of my virtual friends and like me, a writer and blogger. He lives on the East Coast and at one time did live here in Santa Barbara, however the Internet has facilitated our connections and collaborations on topics of shared interest. As in the case with some of my other virtual friends, I'm sure one day we will meet in person -- most likely at an ACHE Congress on Healthcare Leadership.

Last year his latest book Getting It Done was published. He and his co-editor, Steve Fellows, have pulled lessons learned from some of the best and brightest in the healthcare profession on a broad range of topics. I enjoyed the stories, ideas and peaking inside a little unfamiliar territory. Here are a few of the chapters and concepts that struck me.

Overcoming Rural Healthcare Challenges- The complexity that sometimes leads to the marginalization of rural hospitals and in many cases their one and only general surgeon.

Launching and Innovation Revolution in Healthcare - Great examples of breaking out of the old. I especially like the red zones and Chocolate Cafe'!

Documentation as Destiny: A Tool for Survival Why physician documentation is the key ingredient in the determination of payment.

Building a Functional Operating Room Culture Hummm!! I can see how the best candidate for OR medical director is "a retired surgeon or anesthesiologist who likes surgeons and has a background as a high school teacher with a degree in psychiatry." This wonderful chapter also includes the quote "The best way to predict the future is to invent it." (Kay 1989)

Innovations to Address Disruptive Physician Behavior Comprehensive approach and series of progressive interventions and ongoing monitoring, but don't forget docs aren't always the hospital's bully. Use this guidance to address them all for safe and high quality care.

Coaching Healthcare Teams to Improved Performance Breakdowns in communication and poorly managed conflict drive suboptimal team performance and undermine the quality and safety of patient care.

May 23, 2012

By now, many of my regular blog followers should have figured out I'm a girl from New Orleans and I also have a specific interest in emergency preparedness and disaster planning, especially for hospitals. Once again, I get to post about something that blends several interests.

I received a link to the premier issue of the enhanced digital magazine Security Management . It includes an article, Patient Care in a Crisis, that looks at the decisions healthcare providers made in New Orleans in 2005 when Hurricane Katrina came ashore. It explores issues, such as, security and the choice between shelter-in-place and hospital evacuation. The lessons learned and information shared will certainly be of value to those readers with an interest in disaster planning and preparedness. One fact that I did not know before this article was that 35% of the dead bodies recovered after Katrina were found in hospitals.

However, the interactive nature of this eMagazine with embeded short video clips, podcast and an expandable digital map of the U.S. with the number of staffed hospital beds available for all U.S. Zip Codes will be especially interesting to those of you who enjoy new media and emerging technologies. The more interactive nature of this digital magazine does enhance the reader's experience.

For those of you who like apps, you may also be interested in the article that follows on Life Safety Apps. It also includes interactive presentation of content.

The digital issue and healthcare feature is available publicly for the month of May - so check it out soon!

March 02, 2012

It has taken me a while to catch up and recover from being at HIMSS12 last week, but I've finally had a chance to sit down and reflect on what I saw and learned during that busy week. So below are my higlights:

Learning about HealthInfo Island, Health Support Coalition, Cancer Co-Op, AIDS and HIV Support, etc -- communities on the virtual world 2nd Life.

And, getting an update from Zac on Louisiana's HIT/HIE activities.

But, the absolute best part of the week was finally meeting several of my blogger friends in person! Talking with them in person gave us a chance to bring our relationship full circle. Some I just met this past year, but I've known two since first starting to blog in 2005 -- @hospitaltony and @techguy.

February 27, 2012

I was recently interviewed for an article in Healthcare Finance News about the cost of protecting workers against violence. It came about because of a ANA survey looking safety concerns in the workplace and the report that healthcare facilities are not doing enough to keep nurses safe. While we often think of the hospital, workplace violence can, and does, also occur in nursing homes and ambulatory or private practice settings.

Healthcare worker violence is an issue related to security, which falls under the broader umbrella of hospital safety. From a general standpoint, healthcare security is important, but competing priorities sometimes get in the way of organizations doing more to secure access to the facility or expend additional resources on training. Most hospitals and some other healthcare settings do have security staff. However, security staff can't be everywhere at once and just adding more isn't always the best answer.

The best person to identify when something isn't right (a safety or security risk) in their environment, is the person who works in that environment on a daily basis. The result is that we must rely on employees and others in the organization to notice and report any suspicious behavior and to be more defensive in their contact with patients, families, visitors and even other staff. Unfortunately, as an industry we have tried to create warm and inviting environments for the public and healthcare workers have historically been too caring and trusting.

The risks to employee (and patient) security and safety are continually evolving and expanding. I believe our healthcare organizations must create policy that mandates reporting of any suspicious behavior, threats, and/or violence. But, they should also create a culture where staff feel safe in doing so. Organizations can also do more to educate their employees of the evolving risks and help them gain skills to identify risks and respond to difficult situations.

As it relates to our patients (or their families), they are sicker than they have ever been before and unfortunately the ER is sometimes used as a dumping ground for individuals who belong in other settings. We need to help our staff become better at identifying threatening behavior sooner and support them with response from other clinical or security staff. Our organizations also have to develop strong relationships with law enforcement and other community leaders to address concerns as they arise.

As for the investment cost of security ... it is so much less than poor employee morale, high turnover and absenteeism rates, negative media coverage, investigations, fines, litigation, worker's compensation claims, and higher insurance costs. But, keep in mind that a balanced approach is best.

January 30, 2012

The Agency for Healthcare Research and Quality (AHRQ) has sets of toolkits designed to help health care institutions and clinicians provide—and consumers receive—safe, quality health care at various points in the health care process—in the hospital, in the emergency department, in the intensive care unit, in the pharmacy, and when being discharged from one setting to another.

The 17 toolkits were produced under AHRQ's Partnerships in Implementing Patient Safety (PIPS) grant program and include multidisciplinary evidence-based tools, including training materials, medication guides and checklists, that are easily adapted to other institutions and care settings.

Toolkits by Setting Type

Hospital—General – These toolkits contain evidence-based resources to help inpatient facilities improve performance around some of the most common and most serious patient safety problems faced by hospitals today.